CHRONIC CARE MANAGEMENT

Everything you need
to know about Chronic Care Management and Oncology Care Model

CHRONIC CARE MANAGEMENT OVERVIEW

Chronic diseases are among the most prevalent and costly health conditions in the United States. The CMS estimates that over two-thirds of Medicare beneficiaries have at least two chronic conditions, and 14% of enrollees have six or more conditions. This 14% alone accounts for nearly half of total Medicare spending, that’s why it only makes sense that the agency sought to incentivize improved care for its patients with chronic conditions through the adoption of a set of Chronic Care Management (CCM) CPT codes.

WHAT IS CHRONIC CARE MANAGEMENT?

CCM reimburses providers for non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.

Chronic
Care Management is a step towards value-based care, along with practice and
patient success.

HOW WILL YOUR PRACTICE BE PAID FOR PROVIDING CCM SERVICES?

Starting
January 1, 2019, the reimbursable CCM codes are:

WHO IS ELIGIBLE?

PRACTITIONER
ELIGIBILITY

Physicians and the following non-physician practitioners may bill for CCM services:

Certified Nurse
Midwives

Clinical Nurse
Specialists

Nurse Practitioners

Physician Assistants

However, only one health provider who assumes the care management role for a beneficiary can bill for providing CCM services in a given calendar month. While services are provided by a clinical staff person, the service must be billed from the list of practitioners stated above.

PATIENT ELIGIBILITY

Not
all patients qualify for CCM services. Those who do should meet the following
criteria:

Patient must have two
or more chronic conditions.

Conditions are
expected to last at least 12 months or until death of the patient.

Conditions place the
patient at significant risk of death, acute exacerbation, decompensation, or
functional decline.

The Patient Protection and Affordable Care Act (ACA)
of 2010 (also known as PPACA, ACA or Obamacare) has changed the way United
States delivers health care itself. Its primary focus was to lower the costs of
health care generally. Thus, the healthcare industry is experiencing a
transformation involving reimbursement payment models. Medical providers must
weigh the risks of fee-for-service versus value-based reimbursement carefully.

The
transition from volume to value challenges major health care
industry stakeholders to prioritize
higher quality care while simultaneously increasing their clinical and
administrative efficiency.

ONCOLOGY CARE MODEL
(OCM)

With
more than 1.6 Million new cancer cases every year, cancer diagnoses comprise
some of the most common and devastating diseases in the United States. Through
OCM, The Center for Medicare & Medicaid Innovation (CMS Innovation Center)
has the opportunity to achieve three
goals for the effective care of this medically complex population:

better
care

smarter
spending

healthier
people

The
CMS Innovation Center is developing new payment and delivery models designed to
improve the effectiveness and efficiency of specialty care. Oncology Care Model is one of those specialty
models, which aims to provide higher
quality, more coordinated oncology
care at the same lower cost to
Medicare.

OCM
is a five-year model that began in July 1, 2016 and runs until June 30, 2021.
It uses an episode-based, two-part payment approach:
monthly care management payments (i.e., Monthly Enhanced Oncology Services
[MEOS] payments) and potential retrospective performance-based payments (PBPs)
based on lowering episodes’ total cost of care. Each episode is six months in
duration and is triggered by the receipt of either oral or intravenous (IV)
chemotherapy.

PARTICIPANTS AND PRACTICE
REQUIREMENTS

HOW CAN VISAYA HELP
YOU?

The
aging and growing populations plus the significant rise of people living with chronic
diseases are just some of the factors why Healthcare is one of the highest
growth industries in the world. Healthcare employment is expected to continue
its steady growth to reach almost 26% by 2022, according to the Bureau of Labor
Statistics.

Alongside
this significant growth are the bigger challenges of keeping up with the demand
for improved quality of care and better patient outcomes while reducing costs. That’s
why increasing numbers of healthcare organizations and service providers have
turned to outsourcing to meet these needs.

Visaya’s
Chronic Care Management team is composed of highly competent and experienced
Health Information Technicians who are AAPC and/or AHIMA certified. They are
also board certified MDs, RNs, LPNs and LVNs. They work as an extension of your
internal staff to manage CCM patients. Our highly trained nurse navigators will
be your patients’ guide through their chronic care journey. They act as a
one-on-one contact person that educate, advocate and communicate so that
patients and families understand their treatment options with the goal of
achieving better health outcomes.

We
at Visaya understand the importance of addressing and preventing care gaps, both
in terms of the health outcomes and revenues, that’s why we deliver the utmost
care and provide services that will be most beneficial to the patients while
reducing costs both for the patients and the ACOs alike.

Under Visaya’s
Healthcare Information Management services, we customize healthcare solutions that
can surely help ACOs and providers alike in lowering down their costs,
increasing the quality of care and achieving better patient outcomes.

Patients Eligibility
Identification

EHR Integration &
Customization

Patient-Centered Care
Plan

Patient Outreach

Patient Engagement

Efficient Patients
Enrollment

Monthly Care
Coordination

24/7 Care Support

EHR Documentation

Let Visaya be an extension of your CCM practice. Message us now at info@visayakpo.com